layered cases

[Joy Lucas]

Dear Rosemary, from the outset I should say that the approach to layered
cases has much to do with choice and style of practice and case management
although not all of it Hahnemannian.

Whilst taking the case we might see lots of remedies popping up, we might
recognise a miasmatic influence, we might see remedies that each client
could have benefited from years ago etc, but at the end of the case taking
the total symptom picture should be covered by one remedy, one which
encompasses every aspect of the case as it is presented - the simillimum.
This is so for both acute and chronic disease.

Assuming the simillimum has been prescribed then waiting is the key,
remembering that acutes will move quicker than chronic cases.

We are all, or at least we should be, familiar with the good and bad signs
that can develop after the first prescription - I am not going over that now
- but the simillimum is going to remove the symptoms according to the laws
of cure. Then when they are removed you may or may not have a new symptom
picture emerging. If so you have another layer to prescribe on. You must
wait until the action of the remedy has been exhausted.

In your case I felt that not enough of the original sx had been removed, and
he had only presented with the new symptoms of a cough (which could have
been related to the remedy - in this case Nat Mur.) It could also have been
an old sx and not a new one, showing us that the Rx is still working. As I
understand it he was prescribed the Nat Mur in August????? (apologies if
that is wrong) - deep and slow it can be and I personally feel you changed
the remedy too soon especially as it appeared to have been doing good
things. If nothing had happened then yes I definitely would have changed Rx.
The other problem I had was it seemed you were basing your choice of a new
Rx on some of the earlier presenting Sx as well as the new ones of the cough
etc. I found this confusing.

The problems arise with partially correct remedies or satelite remedies I
suppose they could be called. They do odd things - shift symptoms around,
some improvement can be seen for a while etc, another rx then seems to be
called for and that does a bit here and a bit there, then another Rx etc
etc. This makes us feel this is a layered case when in reality the
simillimum has not been prescribed.

With no criticism intended this could be so with your case. Briefly, when I
first read it I saw Ailments from mortification (the way his father treated
him and his intense dislike for him - I also felt that his partner might
have put him down a fair bit as well as he says he got sloppy after he
died), a huge amount of gastric Sx, frenetic lifestyle which carried further
traumas for him, overall quite a lot of rich quality sx such as anticipation
if a time is set (written in upper case by you I gave this a lot of
importance as it seemed to sum up his nervous apprehension about life). I
did and still do think this is an Argent Nit. case. It covers the totality,
it might have needed repeating but it encompasses the case.

You could say that this client has been getting ill since childhood - the
problems seemed to have started with his relationship with his father but
all that is presented and covered in the case. Some kind of grief might have
been the strongest sx and uppermost in the case but it doesn't impy a
layered case. I don't think there are other layers there to emerge - the
true simillimum should cure. This is why I am not keen on the onion metaphor
as it implies that there is ALWAYS another layer to cure. Stanzas 161-171 I
think are the appropriate ones to read up.

So what are the possible signs of a layered case? There are the heavily
drugged cases which require some cleansing before a reliable symptom picture
emerges, there are the one sides cases where there are few sx to go on,
cases of deep pathology might have layers to them, cases that have been
suppressed, cases such as Suzannes recently - that might well have turned
out to be a layered case.

As I said before style of practice comes into play. I have known Homeopaths
to prescribe at the moment the client reaches a poignant part of their
story, then they continue telling their story until the next poignant moment
and another remedy is prescribed and so on. This is still one remedy at a
time based on the totality of the time but in any potential layered case, or
in fact in any kind of case, I believe you should wait until the action of
the remedy is exhausted.

Thanks for reading and best wishes as always, Joy

[Rosemary Hyde]

Thanks, Joy.

I appreciate very much your elucidation of "layered cases." I agree that I
probably did not have the true simillimum from the start in this case -- I
didn't feel I had it, which of course is why I shared the case in the first
place, but the competing sulphur and nat-m images had been too overwhelming
for anything else to emerge. We had made good progress for a few months at a
time first with sulph and then nat-s, getting to a rather impressive 90% or
so clearing of physical symptoms as well as good improvements in his overall
energy. But the basic emotional picture essentially had not changed. That
was the point at which I gave the Nat-m, in early September, I believe,
because obviously such a healing pattern was not going to hold. The order
of healing was wrong.

I concluded from this that I clearly did not have the simillimum, despite
the other positive results. It seemed that I should act on this conclusion
and give a different remedy rather than wait for all the symptoms to
relapse. The emotional picture that remained seemed to me a clear Nat-m one
of being unable to release old griefs or grudges and move from living in the
past to dealing with the present and the future. Over the intervening
months, after our online discussion of the case, as I checked in with him, I
could see that the emotional picture was now shifting very positively under
the Nat-m, and I expected that would resolve the case.

I had been ready, in fact, to give him Arg-n if there remained important
symptoms when I saw him. I had appreciated your arguments very much, and
had thoroughly reworked the information I had. Arg-n fit about as well as
Nat-m had -- quite well but not with a resounding "click" on all levels.
But then I was surprised to see a whole different picture when I did the
in-depth follow-up interview in late January, so my reworking of the old
information no longer seemed to apply.

In any case, thanks to your careful and well presented explanation, I feel
I've gained a deeper understanding of the concept of "layering" in cases,
and I know that will be helpful. I appreciate your forebearance and kind
explanation very much. I guess one thing I still need to learn is how on
earth to figure out the true simillimum when I know I don't have it but
nothing comes out clearly to indicate it, and several polychrests seem to
overlap while none describes the totality of the case. I'll go back to my
initial case records and see if either Lyc or Arg-n should have hit me
between the eyes and, if so, what I obviously missed.

Thanks so much for conducting this activity and putting up with my attempts
to improve my skills by understanding more deeply what has happened and
should have happened.

Rosemary C. Hyde

[Piet Guijt]

Joy wrote,
Dear Joy,

What do you mean here?
Do you mean by 'total symptom picture' all those symptoms you mentioned?
You say the simillimum should cover 'every aspect of the case' even the
acute symptoms?
Your description is about a layered situation, but you say you look for one
remedy in such a case?
Do I understand you correct?
Kind regards, Piet

P.S. I don't think layers are a matter of treatment style, but a matter of
reality.

[Joy Lucas]

Dear Piet, I am not sure why you have a problem with what I write. Again -
when we are taking the case there might be aspects of it that make us thing
this is such and such a remedy - we write it down, make a note of it. Then
later we think of another remedy etc. But at the end of a case we take the
totality, all the symptoms, put it all together, repertorise etc, find the
simillimum, the one remedy which covers everything. This is the Rx which
will cure. Even if the case tuens out to be a layered case it has to be the
totality of sx at any given time. Does this read better or worse for you. I
agree with you about the reality of a layered case. Alas many choose to go
about this differently - hence the notion of style and choice in case
management. Best wishes, Joy
Joy

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[Joy Lucas]

Dear Rosemary, and thank you for this. Wouldn't it be great if we could sit
round a big table and discuss our cases - I guess we would have got to this
stage a long time ago. Thanks again for sharing your hard work, insights,
intelligence, kind words and tenacity. Best wishes, Joy
Joy

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[Dave Hartley]

from www.simillimum.com/Thelittlelibrary.html
Layers in Hahnemannian Homoeopathy
http://www.simillimum.com/Thelittlelibr ... yers363840.
html
-David Little C

The subject of how layers of diseases form in the human constitution is
discussed in detail in the Organon of the Healing Art. The homoeopath must
divide diseases into categories to effectively use the complete homoeopathic
healing system. The first category of pathogenic families are the acute and
chronic disease. To understand how disease layers work in homoeopathic
pathology the practitioner must understand the nature of susceptibility and
predisposition (?31) and how dissimilar disease interact on the vital force
and human constitution (?35-42).

Study Guide: Some modern constitutionalists treat all diseases in the same
fashion regardless of its causes and circumstances. Many of these
individuals believe they are following the teachings of the great 19th
century American homoeopath, Dr. James T. Kent. Did Kent only use
constitutional remedies? Did he treat acute and chronic diseases in exactly
the same fashion? Vide James Kent on Acute and Chronic Remedies by David
Little @simiillimum.com to find the answers to these questions.
http://www.simillimum.com/Thelittlelibr ... cutes.html

The homoeopathic layer theory is closely related to the complete case
history of the individual, the history of the family tree, and the
development of the post natal pathogenic timeline. All human constitutions
are born into this world with inherited predispositions, miasms and
diathesis. From the time of birth they are exposed to the stress and dangers
of our physical world. Every potenital unresolved befallment along the
developmental timeline of the individual must be recorded by the homoeopath.

Each strong disimilar causation has the potential to produce a syndrome of
signs and symptoms. These symptom syndromes may be repress as deeper layers
by newer stronger causations and symptom patterns as the disease state
develops. Most chronic cases are based on mixed aetiologies and complex
layers of symptoms. How do these layer interact? How can they be removed.
What is the homoeopathic methods for treating layers? These questions should
be investigated by Classical Homoeopaths.

To understand layers first of the homoeopath must understand the nature
of susceptibility and predisposition (?31). Then they must study how the
stronger similar diseases over power the similar weaker diseases. Similars
cure because two similar diseases can not exist in the vital force as the
stronger will replace the weaker (?34.). Dissimilar diseases do not cure as
they form active, latent or dormant layers within the human organism. In
order to understand this subject one must look at the processes of similar
and dissimilar natural and medicinal diseases. Vide aphorism ?35 of the
Organon (O'Reilly edition).

"To make this clear, we will consider the following.

1. the process in nature wherein two dissimilar diseases meet together in
one person, and

2. the result of the ordinary medical treatment of diseases with unfitting
allopathic medicines, which are incapable of producing an artificial disease
state similar to the diseases to be cure.

From this, it will become apparent that;

1. not even nature can lift a dissimilar disease that is already present
through a stronger, unhomoeopathic diseases, and

2. the unhomoeopathic employment of ever-so-strong, medicines is just as
incapable of curing any diseases."

Similar remedies cure because a similars have the natural power to remove
weaker similar disease. The primary action of a potentized remedy has more
essential power then a natural disease and thus replaces it in the human
organism. The secondary action of the vital force then removes the natural
disease as well as the homoeopathic remedy during the process of cure. Two
dissimilar diseases can not cure each other. Dissimilar diseases can only
repel, suspend or combine producing complex diseases states in layers within
the constitution. Just because there are layers in the human organism does
not mean that each 'layer' must be treated routinely in some mechanical
manner.

The grand constitutional remedy has the potential to remove several layers
as it unwinds the case corresponding to Hahnemann's Direction of Cure
commonly called Hering's Laws. Nevertheless, it is for the treatment of
layers that Hahnemann develop the complementary strategies of the acute
intercurrent, the genus epidemicus remedy, the anti miasmic remedy, and the
chronic intercurrent. The acute intercurrent plays a role when a strong new
dissimilar acute disease represses the chronic symptoms and displays crisis.
The genus epidemicus remedy is used in acute diseases or common cause and
similar symptoms. The anti miasmic remedy is utilized when a strong miasmic
layer dominates the human constitutional symptoms. The chronic intercurrent
is useful in cases of unresolved diseases involving chronic miasms,
suppressions and iatrogenic diseases which obstruct the cure. The chronic
intercurrents include similar remedies as well as idem remedies like
nosodes, sarcodes and isodes. All of these methods are complementary to
constitutional treatment when they are use correctly within the complete
case management procedure.

Study Guide: In order to utilze Hahenmann's layer doctrine in a proper
manner on must study the Organon and The Chronic Diseases. There have been
many modern renditions of the 'layer concept' but none of these has
presented this material with the clarity of Hahenmann's original theorums.
Many of these layer concepts seem rigid and mechanistic when compared with
the Founder's more flexible and dynamic system. The three major factors in
the development of layers within the human constitution are dissimilarity,
strength and time. Layers may either be active, latent or dormant depending
on the circumstances. The three central aphorism about the nature of layers
of disease in homoeopathic pathology are aphorisms ?36, 38 and 40 of the
Organon. Closely related to the subject of layers is the concept of the
chronological timeline [see:
http://www.simillimum.com/Thelittlelibr ... eline.html ]
of disease cases.

Aphorism ?36.
The Older Stronger Disimilar Disease Repels the New Weaker Disease.

When a person is suffering from a strong chronic diseases it will prevent
all weaker dissimilar diseases from mistuning the vital force. In this case
disease-tuned vital force provides a form of negative immunity to simple
complaints of lesser disease tuning powers. The band of their susceptibility
is only senstive to those diseases which are somewhat similar to the chronic
state. This is how nature performs homoeopathic cures. Unfortunately, the
new similar start that has the potential to cure the old diseases is by
nature just as dangerous if not worse. For this reason Providence has
granted homoeopathic remedies. Vide Layers, Aphorism 36
http://www.simillimum.com/Thelittlelibr ... aph36.html

Aphorism ?38
The Stronger New Disease Suspends the Older Weaker Disease

In the case of a strong acute disease the vital force will suspend the older
weaker chronic disease while it runs the course. Once the acute disorder is
past the old chronic syndrome will reappear. The older weaker dissimilar
disease will become dormant layer within the human constitution as the new
stronger diseases dominates the vital force. Vide Layers, Aphorism 38.
http://www.simillimum.com/Thelittlelibr ... aph38.html

Aphorism ?40.
Two Old Diseases Make a Complex Disease

In the case of a new acquired strong chronic disease or miasm the older
chronic disorders and miasms will also be suspended as deeper layers of the
case. In the case of a long lasting chronic disease the new or older layer
may form a complext disease by each residing in those areas of the organism
to which the parculiar miasm is disposed Vide Layers, Aphorism ?40.
http://www.simillimum.com/Thelittlelibr ... aph40.html
Dave Hartley
http://www.localcomputermart.com
Santa Cruz, CA (831)423-4284

Tri-Cities Computer (TN) |Asheville Computer (NC)
423-952-0983 or 877-245-3362 |(828)285-0240
$9.95 internet http://www.federalisp.com/?page=ispsignup

[Allen Coniglio]

Rosemary wrote in part -
It is in situations like this that I would consider using a nosode and
looking for a miasmatic state rather than a so-called "constitutional". That
might have the effect of clearing up some of the conflicting and/or
overlapping elements of the case.
Allen

[Allen Coniglio]

Joy wrote in part -
There may not ALWAYS be another layer to cure but, I would be willing to bet
that there is ALMOST ALWAYS another layer. Life is complicated today and so
are people. The single remedy cure idea is, IMO, a bit optimistic. My
opinion, of course.
Allen

[Allen Coniglio]

Just my two cents and this may not be exactly to the point of that which
preceded it but, I do believe in layered cases. This has come up many times
on the various lists and has always been hotly debated. I have seen so many
times a remedy strip away the original "layer" that was initially precribed
on, to reveal a different remedy picture or life stage - if not a different
person - underneath. I believe that humans today are extremely complicated
and therefore multilayered and that finding that single remdy "magic bullet"
to cure the whole case is far less likely and far more difficult than it
might have been 200 years ago. Of course, one must always prescribe on the
totality of the symptom picture that appears and use one remedy for one
disease at one time. Just my opinion but, I don't think that anyone could
convince me otherwise at this stage of the game. I am, however, always
willing to listen.
Allen

[Dave Hartley]

Hi Allen,

I always, except in sheer first-aid acutes, include thought on miasm as part
& parcel of
1. taking a complete case
2. understanding/assessing "constitution" (hopefully not from a superficial
angle)

If one learn to consider these in practice, a "deeper" and truer simillimum
may be the result, with far, far less resort to scattered chasing about
after superficial "layers."

I'd welcome any discussion on Hahnemann's case management strategies of
acute intercurrent, anti miasmic remedy, and chronic intercurrent in theory
or practice.

regards,
Dave Hartley
http://www.localcomputermart.com
Santa Cruz, CA (831)423-4284

Tri-Cities Computer (TN) |Asheville Computer (NC)
423-952-0983 or 877-245-3362 |(828)285-0240
$9.95 internet http://www.federalisp.com/?page=ispsignup